中医疗效价值付费的政策实施效果研究——以混合痔为例

Research on the Implementation Effect of TCM Curative Value Payment Policy--Based on the Mixed Hemorrhoids

选择混合痔为样本病种,利用统计学方法t检验,对按疾病诊断相关分组付费(DRG)/按病种分值付费(DIP)医保支付方式改革背景下柳州市中医疗效价值付费政策的实施效果进行评价。结果表明,与西医DRG付费对照组相比,中医疗效价值付费组的住院天数更短、医疗费用更低、医保基金支出更少,这激励了中医院科室和医生的工作积极性,使其能够在新型医保支付方式改革下促进中医医疗的守正、传承和创新。柳州市中医疗效价值付费改革的经验在于,运用中西医同城同病同质同效同价理念,建立了价值疗效与中医优势病种的对接机制;构建了中医疗效价值付费中的“定价-支付-管理-激励”制度;开发了支持中医临床决策与病种管理的信息系统。未来,还应扩大中医优势病种覆盖范围,优化临床路径管理;建立多维度、全过程、动态调整的医疗质量评价体系;施行医生及科室激励措施,在医疗机构间形成良性的竞争环境。

To evaluate the implementation effect of traditional Chinese medicine(TCM)efficacy value payment policy in Liuzhou City in the context of health insurance DRG/DIP payment method reform.Through t-test,chi-square test and other statistical methods,mixed hemorrhoids were selected as the sample disease to evaluate the policy implementation effect of TCM efficacy value payment.The results show that compared with the western medicine DRG payment control group,the traditional Chinese medicine efficacy value payment group has shorter hospitalization days,lower medical expenses,and less medical insurance fund expenditures,which motivates the work enthusiasm of departments and doctors of traditional Chinese medicine hospitals and promote the integrity,inheritance and innovation of traditional Chinese medicine under the reform of medical methods.However,there are also problems such as too strict admission standards for some diseases and low medical insurance payment coefficients.Therefore,it is recommended to take the following measures to improve corresponding policies:optimize and strengthen clinical path management;expand the coverage of dominant TCM diseases;improve the medical quality evaluation system;implement incentives for doctors and departments to promote the realization of value-based medical insurance.